What is Slipped Disc?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

The spinal column is composed of a stack of bones called vertebrae. In the cervical region, there are seven bones, 12 in the thoracic region, and the final five are in the lumbar region. They do not rest directly on top of each other, however; spongy discs cushion them so that they don’t grind against each other, and to withstand the impact of everyday activities like lifting objects, twisting your back, or even walking around. 

The discs have two components to them: The first is a gelatinous interior that requires protection, and the second is that protection. Several conditions can cause weakness or injury to this area and cause the inside of a disc, resulting in pain and discomfort. This condition is known as a prolapsed, herniated, or slipped disc. Numbness may also accompany the pain if the disc has slipped onto a spinal nerve and pinched it. In more serious cases, it is possible to need surgery for repair or removal.

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More About Slipped Disc

lumbar foraminotomy

Slipped discs happen once the outer ring has become too worn out to protect the gelatinous interior any longer, and this is common to experience with age. This is because the discs naturally lose their water over the years, making them much more slippery. There are also certain motions that can cause the disc to slip more easily than others, such as when you twist your back to lift an object. Those whose job requires regular heavy lifting are at the greatest risk for a slipped disc. 

Those who are overweight also have an increased risk for a slipped disc because the discs must carry more weight than normal. Similarly, a sedentary lifestyle and weak muscles can also contribute to this condition. Men are more likely to slip a disc than women are. 

If a severe slipped disc is left untreated, there can be permanent nerve damage. Sometimes, the damage could be serious enough to cut off the nerve function of the cauda equina, meaning you may experience a loss of bladder and bowel control. 

Saddle anesthesia is another complication that can occur in untreated slipped discs. This occurs when the pinched nerves result in a loss of feeling in the inner thighs, around the rectum, and behind the legs. 

Although the symptoms of a mild slipped disc could improve on their own, they can also get much worse. See your doctor if you are no longer able to perform activities like you used to. 

What are the symptoms?

A slipped disc can cause irritation to the nearby nerves, causing pain, weakness, or numbness to a leg or an arm, depending on the exact location. It is possible to experience no symptoms, however, making an accurate diagnosis difficult. Fortunately, most people who suffer from a slipped disc will not need surgery as part of their treatment. 

The majority of slipped discs happen in the lumbar region, but the cervical region by the neck is also vulnerable. Common symptoms of a slipped or herniated disc include:

  • Pain in the arm or leg: If a disc in the lumbar region slipped, then the pain will feel worst in the thigh, calf, buttocks, and potentially even the foot. Slipped cervical discs involve pain around the shoulder and arm. The pain may worsen when coughing or sneezing when sitting in certain ways. 
  • Tingling and numbness: Because the disc tends to slip onto a nerve, you are likely to experience some kind of tingling or numbing in the area near the nerves. 
  • Weakness: Likewise, the muscles that become numb will also get weaker, which can impair your balance or ability to hold items.

As we previously noted, it is possible not to experience any symptoms, which means you may have a slipped disc and not even realize it. Sometimes, they’re discovered during other imaging tests. 

Be sure to speak with a doctor if you are experiencing numbness or weakness along with your back pain. 

How is a Slipped Disc Diagnosed?

Your doctor will request a total medical history before completing a few physical exams to test for neurological damage. 

Questions to expect include information about any other illnesses you may have, previous problems with the spine, injuries faced, and the type of symptoms as well as how any previous treatments have worked. The physical exam includes an abdominal test and checking the standard nerve functions. 

It is not usually necessary to obtain a diagnostic test in order to get the right kind of treatment for your slipped disc pain. However, sometimes your doctor will order these tests for you to learn more information if needed to make an accurate diagnosis. They may also be ordered later if the initial treatment plan doesn’t relieve your pain. 

X-rays alone can show that there is a bony abnormality, but it cannot pinpoint that to a slipped disc compared to something else like bone spurs. Because of this, it is best to use this imaging tool to evaluate other causes for pain in the back, such as a broken bone, displacement, or a tumor. In most cases, the x-rays will appear normal for those who have a slipped disc. Thus, younger patients without too many symptoms may wish to save their money on an x-ray. 

Other specialized tests include an MRI or a myelogram, which is like a CT scan but involves injecting contrast dye directly into the spine. Both of these exams are the preferred imaging types for diagnosing specific nerves that have been pinched and which discs have slipped or deformed. However, the doctor is unlikely to order either test if you do not have symptoms suggesting severe nerve damage, because the findings rarely change the method of treatment. 

Finally, a bone scan can help detect a tumor, healing fracture, or infection that may otherwise explain the pain. 

What are the causes of a Slipped disc?

low back pain

Slipped discs usually occur gradually as you age due to natural disc degeneration. As you get older, the water content of the spinal discs reduces, reducing stability in the vertebrae and making you much less flexible and prone to disc rupture, even with simple movements. 

It is difficult to pinpoint any one cause for a slipped disc because of how much natural wear and tear the discs take as part of everyday living. Sometimes, discs slip when you rely on back muscles instead of the leg muscles to lift heavy objects, or if you were to twist your back while lifting the option. It is also possible for traumatic injury to cause a disc to slip. 

Factors that put a person at greater risk of developing a slipped disc include:

  • Weight: Too much body weight stressing the spine can cause the discs to slip in the lower back 
  • Genetics: Some people are simply born with a genetic disposition towards slipped discs 
  • Occupation: Jobs that require you to lift heavy objects on a regular basis put you at a much greater risk for developing problems of all kinds in the back.

How are Slipped Discs treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of a Slipped Disc

As previously mentioned, slipped disc treatment does not usually require any special equipment as the sequence does not change unless it’s not helping the back pain. If the doctor wants to see your spine in greater detail, he or she may order imaging tests to produce detailed images of the spine and its insides, allowing him or her to pinpoint affected nerves. These tests include:

  • X-rays: An x-ray on its own will not find a slipped disc, but it rules out spinal alignment or tumor concerns. 
  • CT scan: A computerized tomography scanner takes x-rays from a variety of angles and stitches them together into a very detailed image, giving your doctor more information about the structure.
  • MRI: With the help of a powerful magnetic field and radiowaves, an MRI machine produces images of the structures inside the body besides just bone. This is the test that can prove a disc has slipped.

How Does Slipped Disc Compare to Other Spine Conditions?

Although they can appear in the neck region, the majority of slipped discs occur down in the lower back, causing pain in the legs and back. Pain that flares up and reaches down to the foot is known as sciatica. Pain extending below the knee is a sign that a slipped disc is to blame. If the pain does not extend past the knees, then there may be something else to blame. 

  • Collapsed Disc
  • Herniated Disc
  • Herniated Nucleus Pulposus (HNP)
  • Slipped Disc
  • Disc Extrusion
  • Disc Protrusion
  • Pinched Nerve
  • Compressed Nerve

When a cervical disc slip occurs, you’ll experience pain in the armpit, the shoulder blade, and all the way down to a finger or two. You may also feel pain in the middle of the upper back, and this can cause a misdiagnosis of the cause. 

Treating the problem correctly is important, so it’s essential to know all of the symptoms you are having and whether or not they indicate a slipped disc. For example, pressure near the bottom of the spinal cord can result in loss of bladder control, which indicates serious nerve pressure, which is a medical emergency. The sooner you receive treatment from the doctor, the less likely any permanent nerve damage will occur. 

To help narrow down the potential causes of pain, the doctor will ask about your symptoms and complete a physical exam. It is common to check out the spine and test for reflexes, coordination, muscle strength, and how well you can feel stimuli. Sometimes, this examination alone will be enough to make a disc slip diagnosis. However, he or she may also wish to take additional tests to verify his or her suspicion. An MRI will be the most definitive test. 

Nonetheless, the doctor must still exercise caution when interpreting the tests. Results can show advanced disease where symptoms don’t exist, or they may show nothing out of the ordinary in those who are doubled over in pain. Treatment depends on accurately diagnosing the condition and doing so carefully.

Analogy: Blow-Out vs Flat Tire

A skipped disc is like a flat tire, a prolapsed—or herniated disc–is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a slipped disc (flat tire) can progress to become a prolapsed disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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